As an ER Doctor, COVID Taught Me I Don't Matter So I Quit.

Molly Phelps, MD

After nearly 20 years as an ER doctor, I walked away from the profession I once loved and I’m not alone.

According to a new report, 117,000 physicians left medicine in 2021. Each departure cost the healthcare system an estimated half million dollars— $58 billion last year alone—and the ripple effect has already led to worse medical care for all of us. This mass exodus of dedicated professionals is the canary in the coal mine for a growing healthcare crisis and the solution is not more resiliency training for the remaining canaries. It’s time to fix the mine.

As physicians, our indoctrination begins in medical school with an unspoken rule: the only way to be a truly good doctor is to put our patients’ needs above our own at any cost. For example, early in my career when I was eight months pregnant, I contracted H1N1 at the hospital where I was working and despite a 102F fever, never called in sick. Years later, when my mammogram looked suspicious for breast cancer, I created a schedule allowing me to work shifts in the ER after every radiation treatment. Luckily, the biopsy was benign.

Every physician has similar stories — from pushing their IV pole into patient rooms while fighting a gastrointestinal bug to admitting oneself to the hospital at the end of a shift after working with appendicitis. We keep going because what we do matters.

But increasingly, many of us are asking, do we matter? The pandemic and its ongoing aftermath have hastened a growing sense of disillusionment that the answer is actually no— at least not to our healthcare leadership.

There is little doubt that our medical system’s unwavering focus on profitability puts reimbursement and patient throughput above the well-being of its workforce. Before Covid, there was a delicate detente as doctors are notoriously bad at asking for help anyway. But now, as we frantically wave our white flags, we are summarily dismissed.

In the early days of the pandemic, administrators minimized our physical safety. As medical workers succumbed to the virus in both China and Italy, I was admonished for wearing an N95 mask and was told, “you’re going to scare the patients and the nurses will want to wear them, too.” Others received similar messaging and several professional societies were compelled to release statements in support of adequate PPE. As the pandemic continued, our emotional health was disregarded. A recent study found that nearly 70% of physicians report symptoms of depression and one in eight acknowledge suicidal thoughts. I lost all interest in food and eventually dropped to my junior high weight. Of course I went into therapy and got help for my symptoms, but the work—and the dismissiveness—kept coming. The antidote that we needed had to come from our healthcare leaders.

It never did. In fact, it got worse.

There was never any meaningful recognition of the relentless trauma we’d endured, and the disconnect between the support we needed and our leadership’s efforts to help us was striking. Hospital administrators ordered pizzas, encouraged yoga, and told us to keep gratitude journals on our bedside tables. While well-intended, these efforts felt tone-deaf in the aftermath of surge after surge of a deadly pandemic.

Doctors shouldn’t be told how to be well by a committee of managers far removed from patient care. Instead, we should be asked — asked what support we need to stay healthy and what can be changed to help us to do our best possible work.

What would our healthcare system need to do to get us to stay? Probably less than you might think. We need to be seen and trusted.

See that we put our lives on the line and risked the health of our families every single workday before vaccines became widely available. See the moral injury we absorb shift after shift when, despite doing the very best we can, perpetual short-staffing and overcrowding keep us from giving the quality of care we’d want for our loved ones. See that if we’re asking for help, we have tried absolutely everything in our power to fix the situation ourselves and our goal is to do right by our patients. In July of 2021 after nearly 18 months on the front line, I asked my hospital leaders for an unpaid leave of absence to regain my humanity and was told, “then everyone else would want one too,” as my request was flatly denied.

At that moment, I knew I was done.

I’d always planned to remain in the ER for the next 13 years until I retired and instead, I submitted my resignation. For decades, medicine had been my everything and I finally understood that it never loved me back.

There are over 100,000 doctors like me and many of us would have stayed — even under our currently abysmal working conditions — if only we’d been treated as respected partners instead of a depersonalized commodity. There is clearly no easy fix, but we can start improving the well-being of our battered workforce by taking small, attainable steps like encouraging respite and making the effort to show up.

First, establish a sabbatical program immediately. Plugand-play models already exist, so there is no need to reinvent the proverbial wheel. Pilots have mandatory rest periods and soldiers come home between tours of duty, yet we somehow expect our doctors to keep giving their very best care after three brutal years on the frontline. Pragmatically, it’s far less expensive to support short breaks to recharge than it is to train our replacements.

Also, don’t underestimate the power of showing up. In the pandemic’s first year, I saw the head of our hospital in the ER exactly one time for less than five minutes. Physicians would feel far more seen and supported if our leaders made a point to walk in our Danskos, regularly joining us in the trenches to bear witness to our reality and share in our burden.

Keeping our best physicians in the game is clearly in everyone’s best interest. The tipping point is here and we must immediately and radically alter our hospital culture before all of the canaries fly away.

Dr. Molly Phelps is a board-certified emergency physician who is completing a memoir about her time on the pandemic’s front line.

An earlier version of this piece appeared in the San Francisco Chronicle on November 19, 2022.